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Study on the Effect and Mechanism of Huaji Jianpi Decoction on Simple Obesity. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5494224. [PMID: 35529938 PMCID: PMC9071864 DOI: 10.1155/2022/5494224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 12/20/2022]
Abstract
Background As the major type of obesity in clinical, simple obesity has gained increasing attention in recent years. Depending on the etiology and pathogenesis of simple obesity and combined with clinical practice experience, Huaji Jianpi decoction (HJJPD) was established to invigorate the spleen and eliminate dampness; however, the underlying molecular mechanism is yet unclear. Materials and Methods A simple obesity mouse model was established by feeding a high-fat diet to the animals, and the related indexes were analyzed. The mice were divided into the normal, positive control (orlistat), and HJJPD high-dose, medium-dose, and low-dose groups. After 6 weeks of administration, the curative effect of HJJPD was observed. Simple obesity is associated with leptin resistance. The leptin signal transduction pathways mainly include the JAK2-STAT3, AMPK-ACC, LepRb-IRS-PI3K-PDE3B-cAMP, and LepRb-SHP2-MAPKs (ERK1/2) pathways. Therefore, the networks of HJJPD acting on these four pathway-related targets were constructed using the network pharmacology method, and the key nodes were identified. Results After 6 weeks of drug intervention, we found a good therapeutic effect of HJJPD on simple obesity in the mouse model. The biological network analysis showed that HJJPD plays a role in treating leptin resistance in simple obesity by acting on multiple targets in the JAK2-STAT3 pathway via various components. Also, HJJPD can improve leptin resistance in mice by enhancing the binding force of LEP and LEPRB and activating the LEP-mediated JAK2-STAT3 signaling pathway. Conclusion In this study, animal experiments, network pharmacology, and molecular biology were combined to establish a mouse model of simple obesity, confirm the role of HJJPD in the treatment of simple obesity, and preliminarily reveal the related mechanism. Relevant research results will provide a basis for the treatment of simple obesity and the drug discovery.
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Stenberg E, Dos Reis Falcão LF, O'Kane M, Liem R, Pournaras DJ, Salminen P, Urman RD, Wadhwa A, Gustafsson UO, Thorell A. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update. World J Surg 2022; 46:729-751. [PMID: 34984504 PMCID: PMC8885505 DOI: 10.1007/s00268-021-06394-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 02/08/2023]
Abstract
Background This is the second updated Enhanced Recovery After Surgery (ERAS®) Society guideline, presenting a consensus for optimal perioperative care in bariatric surgery and providing recommendations for each ERAS item within the ERAS® protocol. Methods A principal literature search was performed utilizing the Pubmed, EMBASE, Cochrane databases and ClinicalTrials.gov through December 2020, with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. After critical appraisal of these studies, the group of authors reached consensus regarding recommendations. Results The quality of evidence for many ERAS interventions remains relatively low in a bariatric setting and evidence-based practices may need to be extrapolated from other surgeries. Conclusion A comprehensive, updated evidence-based consensus was reached and is presented in this review by the ERAS® Society.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | | | - Mary O'Kane
- Dietetic Department, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Ronald Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands.,Dutch Obesity Clinic, The Hague, Netherlands
| | - Dimitri J Pournaras
- Department of Upper GI and Bariatric/Metabolic Surgery, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, UK
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland.,Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anupama Wadhwa
- Department of Anesthesiology, Outcomes Research Institute, Cleveland Clinic, University of Texas Southwestern, Dallas, USA
| | - Ulf O Gustafsson
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Thorell
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
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Sudlow AC, le Roux CW, Hardwick R, Pournaras DJ. The role of staging laparoscopy in complex bariatric surgery. Clin Obes 2021; 11:e12460. [PMID: 33940659 DOI: 10.1111/cob.12460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022]
Abstract
Determining which patients will benefit from bariatric surgery is complex; however, in those who have had previous bariatric surgery or extensive abdominal surgery, this can be particularly challenging. Decisions are often made based on assumptions rather than a complete assessment of all the anatomical and physiological factors. Adopting the approach utilised in gastrointestinal surgery with a diagnostic or staging laparoscopy, it may be possible to more accurately stage disease and determine fitness bariatric surgery. Laparoscopy is relatively low risk and contributes critical information with regard to access, post-operative anatomical changes and response to anaesthetic. Additionally, it allows surgeons to accurately determine the feasibility of undertaking a procedure and facilitates a more precise discussion with patients regarding suitability for surgery. Denying patients bariatric procedures based on an incomplete assessment of risk is unfair. Scenarios in which patients have had previous surgery, particularly bariatric surgery are increasingly common with the numbers requiring revisional surgery steadily rising. Although only applicable in highly selected, very complex cases, diagnostic laparoscopy adds critical information in the preoperative assessment of patients, not only improving care but potentially widening the numbers considered eligible for bariatric surgery. Our limited experience with staging laparoscopy in patients with previous complex abdominal surgery requiring revisional surgery illustrates the potential benefit it offers in determining patient suitability for further bariatric procedures. The adoption of an established technique, applied in a novel setting offers surgeons the opportunity to more thoroughly assess potentially high risk patients as well as the ability to offer personalised care.
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Affiliation(s)
- Alexis C Sudlow
- Department of Upper GI and Bariatric/Metabolic Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Carel W le Roux
- Department of Experimental Pathology, University College Dublin, Dublin, Ireland
| | - Richard Hardwick
- Department of Upper GI Surgery, Addenbrookes Hospital, Cambridge, UK
| | - Dimitri J Pournaras
- Department of Upper GI and Bariatric/Metabolic Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
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Pournaras DJ, le Roux CW. Understanding the mechanism of how bariatric surgery works is a key component to build the evidence base. Surg Obes Relat Dis 2021; 17:1391-1392. [PMID: 33962875 DOI: 10.1016/j.soard.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Dimitri J Pournaras
- Department of Upper GI and Bariatric/Metabolic Surgery, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, United Kingdom
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
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Wang LH, Lv SY, Liu YR, Chen X, Wang JJ, Huang W, Zhou ZY. Comparative effectiveness of herb-partitioned moxibustion plus lifestyle modification treatment for patients with simple obesity: A study protocol for a randomized controlled trial. Medicine (Baltimore) 2021; 100:e23758. [PMID: 33545941 PMCID: PMC7837822 DOI: 10.1097/md.0000000000023758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Obesity is a global public health issue, which results in many health complications. Moxibustion may serve as an alternative management for simple obesity, where pharmacological therapy is always difficult to be accepted by the majority of obese patients based on its safety. However, the effects of herb-partitioned moxibustion as obesity intervention have not been confirmed. This study is designed as a single-blinded, 3-dummy randomized controlled trial to evaluate the efficacy and safety of herb-partitioned moxibustion plus lifestyle modification treatment in patients with simple obesity. METHODS AND ANALYSIS This study will be a randomized, controlled trial conducted from April, 2019 to April, 2021 that includes 108 participants who have simple obesity and meet the eligibility criteria. The participants will be randomly divided into 3 treatment groups: heat application group, medicated plaster group, or herb-partitioned moxibustion group. Each treatment will last 4 weeks. The primary outcomes will be the clinical effectiveness. The secondary outcome measures include participants' obesity-related indicators, the IWQOL-Lite scale, and the syndrome score of Traditional Chinese Medicine. Adverse events will be recorded during the intervention period. ETHICS AND DISSEMINATION Ethical approval of this study was granted by the Ethics Committee of Hubei Provincial Hospital of Traditional Chinese Medicine on 15 November 2018 (Ethics Reference No: HBZY2018-C24-01). Written informed consents will be provided by all participants before they were enrolled in this study. TRIAL REGISTRATION NUMBER NCT04606680.
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Affiliation(s)
- Li-Hua Wang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine/Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion
| | - Si-Ying Lv
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Yi-Ran Liu
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Xia Chen
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Jia-Jie Wang
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Wei Huang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine/Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion
| | - Zhong-Yu Zhou
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
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6
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Wang LH, Huang W, Zhou W, Zhou L, Zhou XL, Zhou P, Yan Y, Zhou ZY, Wang H. Moxibustion combined with characteristic lifestyle intervention of Traditional Chinese Medicine in the treatment of abdominal obesity: A study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e22855. [PMID: 33120822 PMCID: PMC7581175 DOI: 10.1097/md.0000000000022855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Abdominal obesity occurs when excessive visceral and subcutaneous fat is built up around the abdomen and stomach, which negatively impacts human health. Moxibustion, arose from Traditional Chinese Medicine (TCM), has been widely applied in the treatment of abdominal obesity. Several studies have shown the positive effects of moxibustion in prevention and treatment of endocrine issues and excess body weight. In this context, our study aims to examine the safety and efficacy of the combination of moxibustion and characteristic lifestyle intervention of TCM in the treatment of abdominal obesity. METHODS/DESIGN This study will be a multicenter, randomized, controlled trial conducted from September 2020 to January 2022 that includes 150 participants who have abdominal obesity and meet the eligibility criteria. The participants will be randomly divided into 3 groups in a 2:2:1 allocation ratio. The intervention group will receive moxibustion combined with characteristic lifestyle intervention of TCM; the other group will receive moxibustion combined with lifestyle intervention; the control group will receive lifestyle intervention only. Eight-week moxibustion sessions will be provided to participants assigned to the 2 intervention groups. The characteristic lifestyle intervention of TCM will also last 8 weeks, whereas the lifestyle intervention will last 12 weeks including 8-week treatment period, 4-week follow-up period. The primary outcome is the waist circumference measured by a tape measure. The secondary outcomes include obesity-related indicators, serum biochemical indexs, blood pressure, conversion score of physical symptoms, and measurement of the scale. Adverse events will be recorded during the treatment and follow-up period. DISCUSSION The results are expected to provide clinical evidence for the application of the combination of moxibustion and characteristic lifestyle intervention of TCM in patients with abdominal obesity. TRIAL REGISTRATION ClinicalTrials.gov, NCT04501198, Registered on 9 June 2020.
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Affiliation(s)
- Li-Hua Wang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine/Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion
| | - Wei Huang
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
| | - Wei Zhou
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
| | - Li Zhou
- Department of Acupuncture, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan
| | - Xiao-Li Zhou
- Department of rheumatology, Shanxi Provincial Hospital of Traditional Chinese Medicine, Shanxi
| | - Peng Zhou
- Department of Acupuncture, Shenzhen Bao’an Traditional Chinese Medicine Hospital Group, Shenzhen
| | - Yan Yan
- Department of Acupuncture, Xiangyang Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Zhong-Yu Zhou
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
| | - Hua Wang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine/Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion
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Sudlow AC, Le Roux CW, Pournaras DJ. Long-term outcomes of bariatric surgery in patients with diabetes. Expert Rev Endocrinol Metab 2020; 15:141-146. [PMID: 32292077 DOI: 10.1080/17446651.2020.1754191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/07/2020] [Indexed: 01/06/2023]
Abstract
Introduction: Initially seen as a weight-loss operation, bariatric surgery is now recognized as a metabolic procedure with a critical role in the management of type 2 diabetes mellitus (T2DM). Early improvement in glucose metabolism is a remarkable effect of surgery; however, what deserves equal thought are implications for long-term diabetes control and relapse. Evidence suggests the metabolic effects of surgery fatigue and a proportion of patients will experience relapse of T2DM, with or without weight regain. Herein, we discuss the evidence examining the durability of these effects and approaches to improve long-term control.Areas covered: PubMed, Embase, CENTRAL, and Medline were searched for trials looking at outcomes for patients with obesity and T2DM undergoing bariatric surgery between January 2000 andDecember 2019. Additional studies were found by searching publications from related journals and references.Export opinion: Bariatric surgery is a safe and effective treatment for T2DM and obesity however the response to surgery, like any other treatment is variable. Some patients will experience a relapse of diabetes in the long term. Recent developments in pharmacotherapy present an opportunity to augment or sustain what can be achieved with surgery. Combinational treatment may dramatically change the way both diseases are managed.
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Affiliation(s)
- Alexis C Sudlow
- Department of Upper GI Surgery, Southmead Hospital, Bristol, UK
| | - Carel W Le Roux
- Department of Experimental Pathology, University College Dublin, Dublin, Ireland
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Sudlow A, le Roux CW, Pournaras DJ. Review of multimodal treatment for type 2 diabetes: combining metabolic surgery and pharmacotherapy. Ther Adv Endocrinol Metab 2019; 10:2042018819875407. [PMID: 31579501 PMCID: PMC6759694 DOI: 10.1177/2042018819875407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022] Open
Abstract
Treating type 2 diabetes mellitus (T2DM) in patients with obesity remains a challenge for physicians, endocrinologists and surgeons, a fact supported by uncontroverted evidence from studies looking at mortality and associated morbidity. Metabolic surgery remains the most effective treatment for obesity and T2DM with evidence demonstrating an improvement or resolution of symptoms of T2DM and a reduction in a mortality and rates of cardiovascular events compared with pharmacotherapy alone. While these results are promising, two important limitations must be recognized and addressed. With regards to long-term remission of T2DM, the metabolic benefits of bariatric surgery appear to fatigue with time and a proportion of patients will not maintain normoglycaemia without pharmacotherapy. Second, there has been noteworthy progress in the development of several classes of medications for the treatment of T2DM which were unavailable when the original studies comparing the effects of bariatric surgery with pharmacotherapy were conducted. Recognizing the need for further treatment following metabolic surgery for long-term disease control in conjunction with the availability of newer medications offering more effective, nonsurgical treatment presents a critical turning point in treatment treating obesity. While the traditional approach would be to determine the superiority (or non-inferiority) of these agents compared with surgery, clinicians and surgeons must acknowledge the limitations of this attitude towards treatment given evidence from fields such as cancer, where a combinational approach is the gold standard. Recent advances in pharmacotherapy, present not only a novel approach to medical therapy but a renewed impetus to investigate what can be achieved through multimodal care.
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Affiliation(s)
- Alexis Sudlow
- Southmead Hospital, Department of Upper Gastrointestinal Surgery, Bristol, UK
| | - Carel W le Roux
- University College Dublin, Department of Experimental Pathology, Dublin, Ireland
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Pournaras DJ, Hardwick RH, Safranek PM, Sujendran V, Bennett J, Macaulay GD, Hindmarsh A. Endoluminal Vacuum Therapy (E-Vac): A Treatment Option in Oesophagogastric Surgery. World J Surg 2018; 42:2507-2511. [PMID: 29372375 PMCID: PMC6060786 DOI: 10.1007/s00268-018-4463-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Leaks from the upper gastrointestinal tract often pose a management challenge, particularly when surgical treatment has failed or is impossible. Vacuum therapy has revolutionised the treatment of wounds, and its role in enabling and accelerating healing is now explored in oesophagogastric surgery. Methods A piece of open cell foam is sutured around the distal end of a nasogastric tube using a silk suture. Under general anaesthetic, the foam covered tip is placed endoscopically through the perforation and into any extra-luminal cavity. Continuous negative pressure (125 mmHg) is then applied. Re-evaluation with change of the negative pressure system is performed every 48–72 h depending on the clinical condition. Patients are fed enterally and treated with broad-spectrum antibiotics and anti-fungal medication until healing, assessed endoscopically and/or radiologically, is complete. Results Since April 2011, twenty one patients have been treated. The cause of the leak was postoperative/iatrogenic complications (14 patients) and ischaemic/spontaneous perforation (seven patients). Twenty patients (95%) completed treatment successfully with healing of the defect and/or resolution of the cavity and were subsequently discharged from our care. One patient died from sepsis related to an oesophageal leak after withdrawing consent for further intervention following a single endoluminal vacuum (E-Vac) treatment. In addition, two patients who were successfully treated with E-Vac for their leak subsequently died within 90 days of E-Vac treatment from complications that were not associated with the E-Vac procedure. In two patients, E-Vac treatment was complicated by bleeding. The median number of E-Vac changes was 7 (range 3–12), and the median length of hospital stay was 35 days (range 23–152). Conclusions E-Vac therapy is a safe and effective treatment for upper gastrointestinal leaks and should be considered alongside more established therapies. Further research is now needed to understand the mechanism of action and to improve the ease with which E-Vac therapy can be delivered.
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Affiliation(s)
- D J Pournaras
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals, Hills Rd, Cambridge, CB2 0QQ, UK.
| | - R H Hardwick
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals, Hills Rd, Cambridge, CB2 0QQ, UK
| | - P M Safranek
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals, Hills Rd, Cambridge, CB2 0QQ, UK
| | - V Sujendran
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals, Hills Rd, Cambridge, CB2 0QQ, UK
| | - J Bennett
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals, Hills Rd, Cambridge, CB2 0QQ, UK
| | - G D Macaulay
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals, Hills Rd, Cambridge, CB2 0QQ, UK
| | - A Hindmarsh
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals, Hills Rd, Cambridge, CB2 0QQ, UK
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Roberts GP, Kay RG, Howard J, Hardwick RH, Reimann F, Gribble FM. Gastrectomy with Roux-en-Y reconstruction as a lean model of bariatric surgery. Surg Obes Relat Dis 2018; 14:562-568. [PMID: 29548882 PMCID: PMC6191023 DOI: 10.1016/j.soard.2018.01.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/21/2017] [Accepted: 01/29/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Altered enteroendocrine hormone responses are widely believed to underlie the beneficial effects of bariatric surgery in type 2 diabetes. While elevated postprandial glucagon-like peptide-1 (GLP-1) is considered one of the mediators, increased postprandial glucagon levels have recently been implicated. OBJECTIVES We investigated hormonal responses in lean patients after prophylactic total gastrectomy (PTG), as a model of Roux-en-Y gastric bypass without the confounding effects of obesity or massive weight loss. SETTING University hospital, United Kingdom. METHODS Ten participants after PTG and 9 healthy volunteers were recruited for oral glucose tolerance tests. Plasma glucose, insulin, GLP-1, peptide YY, glucose-dependent insulinotropic-polypeptide, glucagon, oxyntomodulin, glucagon(1-61), and glicentin levels were assessed using immunoassays and/or mass spectrometry. RESULTS PTG participants exhibited accelerated plasma glucose appearance, followed, in 3 of 10 cases, by hypoglycemia (<3 mM glucose). Plasma GLP-1, peptide YY, glucose-dependent insulinotropic-polypeptide, glicentin, and oxyntomodulin responses were elevated, and glucagon appeared to rise in PTG participants when measured with a glucagon-specific enzyme-linked immunosorbent assay. We revisited the specificity of this assay, and demonstrated significant cross-reactivity with glicentin and oxyntomodulin at concentrations observed in PTG plasma. Reassessment of glucagon with the same assay using a modified protocol, and by liquid chromatography-mass spectrometry, demonstrated suppression of glucagon secretion after oral glucose tolerance tests in both PTG and control cohorts. CONCLUSIONS Care should be taken when assessing glucagon levels in the presence of elevated plasma levels of other proglucagon products. Substantial elevation of GLP-1 and insulin responses after PTG likely contribute to the observed hypoglycemia, and mirror similar hormone levels and complications observed in bariatric weight loss patients.
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Affiliation(s)
- Geoffrey P Roberts
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom; Cambridge Oesophago-gastric centre, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Richard G Kay
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - James Howard
- LGC Limited, Newmarket Road, Fordham, Cambridgeshire, United Kingdom
| | - Richard H Hardwick
- Cambridge Oesophago-gastric centre, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Frank Reimann
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Fiona M Gribble
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.
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Girardot-Miglierina A, Clerc D, Suter M. Gastric liposarcoma in a patient with severe obesity. Ann R Coll Surg Engl 2018; 100:e88-e90. [PMID: 29484946 PMCID: PMC5958859 DOI: 10.1308/rcsann.2018.0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 01/11/2023] Open
Abstract
Liposarcoma is the most common soft tissue sarcoma in adults. Predominant locations are the limbs and retroperitoneum. Intra-abdominal liposarcoma represents only 2% of all cases and visceral location is exceptional. Gastric liposarcoma is extremely rare, with fewer than 20 cases reported. The treatment of choice is wide en-bloc surgical resection. If the tumour arises in the area of the cardia, resection involves resection of the proximal stomach as well as the distal oesophagus. Traditional reconstruction with oesophagogastrostomy often leads to troublesome reflux. We report a case of gastric liposarcoma arising in the gastro-oesophageal junction in a severely obese patient.
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Affiliation(s)
| | - D Clerc
- Department of Surgery, Riviera-Chablais Hospital, Monthey, Switzerland
| | - M Suter
- Department of Surgery, Riviera-Chablais Hospital, Monthey, Switzerland
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